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The July 29 New York Times front-page headline proclaimed, “Doctor Shortage Likely to Worsen With Health Law,” followed by a subhead stating that “primary care is scarce.” My first reaction was amazement; they're just figuring that out now? I've been predicting these issues for more than a year, and hospitals preparing for the change have been doing so far longer than that. Still, it was pretty astounding to see the nation's leading newspaper finally spell it out in black and white.

I asked a few leaders of the larger groups how much longer they thought the job market for EPs would continue to be overwhelmed with openings and what they were doing to keep up with the demand. One regional medical director said the question was complex because of changing regulations, court rulings, presumed increases in ED volumes, limited residency programs, and increased use of physician extenders, but that he thought the EP shortage would continue well into the future. He said incentives help keep his company's retention rate high. They are also focusing on using scribes in some locations and expanding the floater physician team for additional support where needed.

One would assume that this skyrocketing need would make salaries rise, but that has not been the case. More groups are offering higher front-money perks, but salaries are staying on par with last season and are even going down a bit, particularly in parts of the Northeast and Southwest. The availability and size of sign-on bonuses is location-specific and outside popular lifestyle areas. Loan forgiveness is a large group or employee perk, primarily in location-challenged areas, but not something to be found in smaller, democratic groups.

Average salaries in the Northeast are under $300,000 in all states but Connecticut where the average sits right at that number. Massachusetts comes in at about $280,000, New Hampshire at $275,000, and as usual, New York is offering an average annual income of $260,000, an abysmal rate when compared with the cost of living. Look for peaks as high as $400,000 in Massachusetts but only in one or two partnership opportunities. Sign-on bonuses are low, averaging $5,000 to $15,000, although New York has one or two location-challenged venues offering as much as $50,000 plus some loan payback. Loan payback in other northeastern states is sporadic.

The Middle Atlantic states have some hot spots, particularly in Virginia and West Virginia. High levels in Virginia partnerships can reach $450,000, and averages around the state come in at $365,000 with sign-on bonuses topping out at $30,000. Pennsylvania has the best chance for high front-money, and the income averages are in the $315,000 range, with significantly higher incomes west of Philadelphia. Compensation in the Pittsburgh region runs as much as 35 percent higher. Maryland has some strong potential averaging $305,000 with big perks in the western part of the state. Look for $350,000 to $400,000 in West Virginia. New Jersey provides a wide range with a high of $390,000 and a low of $243,000. Maryland and West Virginia provide the best chance for the front-money perks outside Pennsylvania.

Mississippi tops the Southeast again with an average of $400,000 around the state, including a partnership or two along the Gulf Coast; one even claims $350 an hour as a partner. Florida and Kentucky have group opportunities that promise $500,000 potential as partners, but the statewide norms are closer to $300,000-$325,000. Alabama, Georgia, and North and South Carolina are all in the same range, with pockets of $400,000 potential in Georgia and North Carolina. Louisiana is seeing a strong hike in income, coming in with averages in the $360,000 level, just nosing out Tennessee's averages of $350,000. Residents who sign early with one large group there can receive a stipend as high as $36,000. Second-year residents earn $1,000 per month, and that goes up to $2,000 per month in the third year. Florida has some loan payback programs as do Kentucky and South Carolina. Sign-on bonus averages are highest in Florida, Mississippi, and Tennessee — as high as $40,000 — but averages in the region are closer to $25,000.

Incomes in the West run the gamut with lows in Colorado averaging $250,000 and highs in California more than $400,000 because of heavy use of RVU compensation models by the bigger groups. CEP America reported that guaranteed hourly rates, annual profit-sharing, and ownership of partnership assets set their incomes about 10 percent higher than others in the state. They also have loan programs, new hire bridge loans, and even maternity/paternity loans for qualified physicians. The other big payday comes from Texas with averages of $350,000 and high levels in the $450,000 range. You can also find strong perks in the state. Nevada and Arizona are averaging under $300,000 with very little up front. Hawaii isn't worth discussing, and Utah isn't talking. Bright spots exist in Oklahoma with an average income of $350,000, and New Mexico ranks just under that at $325,000. Sign-on levels are all over the place but highest in Texas.

The Midwest is the land of front-money with strong loan payback, sign-on bonuses, and even stipends in Iowa, Illinois, Ohio, and Wisconsin. Wisconsin has the highest income average at $395,000, just beating out Iowa at $390,000 and Illinois and Nebraska at $375,000. Missouri and Kansas are averaging $345,000-$350,000 with low sign-on bonuses in the $15,000 range. Indiana and the Dakotas are averaging $335,000-$340,000, with Michigan and Ohio sitting at the lowest point in the region with $290,000 and $300,000 averages respectively. With such high levels of need in Ohio, lower incomes can be a problem. The best incomes appear to range from $350,000-$400,000 in the northwest portion of the state. High spots of $500,000 are being reported in Wisconsin, Iowa, and Illinois, but some of those reported actually include the addition of one-time perks.

As usual, bringing up the rear is the Pacific Northwest. The bright spot may be the averages of $320,000 in Washington and $325,000 in Oregon, plus strong perk potential. Montana and Idaho are well under the $300,000 average with no front-money being reported, and I found only one income report in Wyoming that came in at $160-$175 an hour. Then there is the listing for a job in Anchorage, Alaska, claiming to pay $289 to $363 per hour!

These are averages, and shouldn't be treated as set-in-stone rates to be demanded on an interview. It's a matter of supply and demand. Where the demand is higher and the supply lower, the money is higher in most cases. Location-challenged areas are usually the most lucrative. If you are lucky enough to get an interview in Utah or Colorado, don't lead with “what's your sign-on bonus?” They are likely to reply, “How much do you want to pay us?”

Happy job hunting!

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